The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
The times are changing and moms have athletic goals, want to exercise at high-intensity or lift heavy weights, and want to be able to continue with their exercise routines during pregnancy, after baby and with healthcare providers that support them along the way.
In this podcast, we are going to bring you up-to-date health and fitness information about all topics in women's health with a special lens of exercise. With standalone episodes and special guests, we hope to help you feel prepared and supported in your motherhood or pelvic health journey.
The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health
Beyond the 6-Week Checkup: Reimagining Postpartum Fitness
Revolutionary new research is transforming how we approach postpartum exercise, and it's about time we talk about it. The 2025 Canadian guidelines for physical activity throughout the first year postpartum have finally been published, and they're challenging outdated restrictions that have limited new mothers for generations.
As a pelvic floor physical therapist and researcher witnessing this paradigm shift firsthand, I'm sharing the ten key points from these groundbreaking guidelines that prioritize both physical and mental wellbeing. From encouraging early light activity immediately after birth to debunking myths about waiting 12 weeks for running, these evidence-based recommendations create space for women to trust their bodies and progress at their own pace.
The guidelines take a refreshingly holistic approach, acknowledging that the postpartum period presents unique challenges that might make exercise difficult. Rather than imposing rigid timelines, they advocate for individualized, symptom-based progression and emphasize that some movement is better than none. Most importantly, they recognize the critical role exercise plays in mental health recovery—something I experienced personally during my recent miscarriage journey, where running became my emotional lifeline. This research confirms what many mothers have intuitively known: movement matters for our minds as much as our bodies.
Curious about how these guidelines might change your approach to postpartum fitness? Download the full document from the British Journal of Sports Medicine website and join the conversation about reimagining recovery after childbirth. Share your thoughts and experiences—I'd love to hear how you're navigating your own return to movement!
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Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise, whether you're a recreational exerciser or an athlete. We want to talk about all of the things that we go through as females, going into this motherhood journey. We're going to talk about fertility, pregnancy and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get started. Hello everybody and welcome to the Barbell Mamas podcast. Christina Previtt here and a couple of weeks ago I did a podcast episode on a very new piece of research that was coming out around our international Delphi consensus on contraindications to exercise in the postpartum period. In that podcast I talked about how it is part of a very big project, which I'm only the tiniest bit which was part of that Delphi project, but this huge project that encompassed multiple years of work and multiple systematic reviews in order to get it to its publication, and that is our 2025 Canadian guideline for physical activity, sedentary behavior and sleep throughout the first year postpartum. So this is our first ever return to sport, return to exercise guideline and it got published late last week, and so I thought today I would go through this guideline, now that we can finally talk about it it's so exciting about some of the key points and then give a little bit of commentary on why it's important. So, to recap that previous podcast, I had talked about how the International Delphi had advocated for the removal of the medical clearance requirement for exercise in the postpartum period for a variety of reasons. Right, we don't really have good research that changes outcomes. We know that there's a lot of people who need to get back to movement in the postpartum period and some of our new data is showing that, especially for mood, returning to exercise early postpartum can help with some of our perinatal mood disorders, and it's coming.
Speaker 1:The mental health piece is becoming a very, very big component for advocating for early return to exercise, and I've talked about that with me where, with my miscarriage, I was talking to Dr Davenport, my supervisor, today and I was saying to her, like it was just last week, so Thursday, that my HCG got down to zero and I was. I got the confirmation of miscarriage November 16th. So it has been a very long process but I truly, now that I'm kind of on the other side of this loss I, you know, I'm still emotional about it but running which I never thought I would say as somebody who was a barbell athlete for a really long time, it saved my mental health. I truly believe that, about being in and going through that loss, that it was definitely something that was really important to me. So, as we are learning more, that mental health piece is becoming a very, very critical component of this conversation and honestly I would probably argue just, you know, with my clinical lens that I would rather have a mom who's seen me for a bit of leaking than you know have her life so turned upside down in the throes of postpartum depression, anxiety, ocd or psychosis, and so it's. There's just so much that's changing in this space and it makes me so excited to talk about it because we are going to take this holistic lens and this guideline absolutely did do this and I am just so like excited and proud to even be in the orbit of these authors, and so let's kind of talk about it. So in the consensus, this guideline, there's 10 key points that are on the second page, and you can go to the British Journal of Sports Medicine. You can download this for yourself. I highly recommend you do. It goes into a lot of detail, but I want to talk about some of these key points. Then you can deep dive if you wish.
Speaker 1:Number one postpartum women and people are encouraged to accumulate at least 120 minutes of moderate to vigorous physical activity for clinically meaningful health benefits, and so this is outside of maybe the early two to three week window of initial healing aiming to ramp up intensity to get to this threshold. And again, that was based on our systematic review data, not our I was not on the author team, but our generally that that is the threshold that seems to have the biggest health benefits, and that one in particular is around cardiometabolic risk factors, so just heart health in general and mood disorders. So that is a little bit lower than our guidelines, which say 150 minutes, and there seems to probably be some sort of dose response that even a little bit helps until we get to this like where you're going to get the most benefit, which is going to be 120, essentially to 150 minutes. Number two initiating light intensity.
Speaker 1:Physical activity after childbirth is encouraged as early mobilization has been associated with better health outcomes. This is true with vaginal birth and cesarean section, the hospital after C-section. Those who get more steps moving around their room have less post-op complications than those that move less. Right, because we know that that sedentary behavior outside of course you're going to be healing and recovering. I'm not saying run a marathon, but light physical activity, walking around is okay. Walking around is okay. And you all know that my bias is that I am very against the 555 or 777 of staying in the bed for multiple days. And it's because of this research. This one I love, actually, three, four, I love all of them, but three, four and five are definitely bias confirming for me. And if you all have been listening to the podcast for any length of time, you know that I'm going to be totally on board with this Progression towards moderate to vigorous physical activity.
Speaker 1:Recommendations and beyond should be individualized, gradual and symptom-based, reflecting the time needed to heal from pregnancy and childbirth, physical and mental health and readiness to engage in postpartum physical activity. We have focused so much on tissue healing that sometimes we forget about all of the aspects of a person that matter to. We know that body readiness you know the amount of fitness that you did during your pregnancy, what you did before your pregnancy, how much fitness you maintain during your pregnancy is going to be something that is going to create a maybe a different slope of your return to exercise than somebody who had hyperemesis gravidarum and, even with the best of intentions, didn't get to exercise a lick the entire pregnancy because they were fighting flu, vomiting, nausea type symptoms the entire pregnancy. They're going to have a lot less strength finishing their pregnancy and they may have to go a little bit slower right. Somebody who's had a C-section and had a delayed wound healing is going to be someone is going to be different from somebody who had a C-section that didn't have those complications. Creating these blanket guidelines does not help sometimes outside of like, hey, we need to protect your stitches or your glue so that we don't have that delayed wound healing or we don't have to go in and redo it.
Speaker 1:But you know, outside of that, everyone is going to have their own slope of the line and if you are in pelvic floor physiotherapy as a patient or if you are a provider, it's going to be different. If you had a third degree tear or minimal tearing, if you had a vaginal delivery, like there are so many different things that are going to be individualized. And then how you feel within your own body is going to matter. Right, if you are afraid to move your body postpartum because it feels so foreign to you, it can also sometimes slow your progression because you want to inch in a little bit more slowly than someone who doesn't have as much fear of movement and is just ready to jump back in. And those are all based on your own past experiences, your own feelings within your body, and I'm not saying that one is better than the other. Right, you're going to find that trajectory that works for you and we have some of these symptoms that are working as navigational buoys to guide the way. So love that it's saying this right, and so many of, especially some of my medical providers. They kind of want, like a I can do this at this week and I can do that at that week. And I don't mean to paint everybody with the same brush, but we tend to get taught in medicine and this is true a little bit too in physiotherapy, where we want these protocols and it just doesn't work like that. And I think being a clinician researcher has always been really wonderful for me because I get to embrace this gray and I try and bring that pragmatism into some of my research.
Speaker 1:Okay, number four is daily pelvic floor muscle training is encouraged to reduce the risk of urinary incontinence, especially early on, right, like this down with Kegel's movement. I am very against it because our evidence is very, very clear and one of our, one of the systematic reviews that got published related to this guideline, spoke to that that having pelvic floor muscle training, especially in that early recovery phase, right, the pelvic floor muscles if you had a vaginal birth, were injured. We're going to respond by trying to strengthen and recondition those pelvic floor muscles. It stands to reason that doing some amount of pelvic floor muscle training what we have from a dose like how many you need to do totally again, going to be individual, but it's encouraged to reduce the risk of urinary incontinence. Chef's kiss, love it. Okay, number five Okay, this is definitely my favorite, but I say that about everything, but this one is very good. Number five is returning to rutting and resistance training is generally safe Once surgical incisions or perennial tears have sufficiently healed and vaginal bleeding does not increase with moderate to vigorous physical activity.
Speaker 1:Beginning or returning to these activities in the first 12 weeks following childbirth is encouraged and better quality, and it actually creates better quality sleep and is associated with improved mental health. I'm going to just like let that lie there for a second right, because these are these activities high load resistance training right and that's going to be relative. I'm not saying go back to your 100 max of 12 weeks and running. There's a lot of thoughts around we should wait till 12 weeks, but runners are going to run. When we actually look at the behaviors of many of our runners, they tend to want to go out for at least a walk jog. Some go out at four weeks. Others are going to wait 12 weeks or 16 or six months, depending on what's going on with them, but a lot of our runners are returning a lot earlier and they're doing well. So this guideline actually debunks that. It says, based on our recommendations, that waiting for 12 weeks isn't necessary, which I love. Ok, then it kind of goes into the nuance of this right, we don't want to say that there are no reasons or justifications for slowing down or delaying exercise in the early postpartum period.
Speaker 1:So number six is those with potential contraindications to physical activity right Cesarean section with symptoms that worsen with moderate to vigorous physical activity, should consult with healthcare and may be advised or require some modification for returning to activity. Returning to activities of daily living, however, is recommended for all postpartum women and people because of the adverse effects of activity restriction and bed rest. So if you do go back to exercise, stuff starts to feel bad or you are a little bit symptomatic, like you pee a little bit, which we would expect for somebody who's going back to high impact or high loading early postpartum when you're re-exposing yourself to those weights, but then it starts to get way worse or it's not improving or you think that there might be something else going on. Then we're going to seek care right by a medical provider. What I loved about this was that it gave a buoy right, a clinical buoy of okay, we might need a little bit more screening for this, we might need a little bit of help, we might need a little bit of modification or personalization, but that message was not stop doing it until you see medicine. It was saying we might need to, like you know, do some modifications or come at this in a different way, or change your volume or change your range of motion or change your load, and so you might want to consult with somebody who can help you create that bridge. Just loved it, and because of this.
Speaker 1:It said that postpartum women and people who follow this guideline for physical activity, trying to reduce sedentary behavior and sleep, will likely experience a large improvement in their psychological wellbeing reduction in the prevalence of depression and symptoms of depression and anxiety. Pelvic floor health. Musculoskeletal health, with a reduction in low back pain and pelvic girdle pain and symptoms. Cardiometabolic health, which includes improvement in postpartum weight, body mass index and blood lipids. And a reduction in fatigue, while not experiencing adverse effects like reduced breast milk supply or injury. Experiencing adverse effects like reduced breast milk supply or injury that last one a lot of people will say things to me like oh, as soon as I started exercising more or heavily, my breast milk supply went down.
Speaker 1:What we know is that if you are fueling and hydrating appropriately to make up for the calories lost in sweating in the postpartum exercise period, while you are still lactating, breastfeeding, chest feeding. In that situation, where energy intake, calorie intake, is sufficient, breast milk supply will not go down. However, what can happen is when you are exercising, you are sweating, you are burning calories. If you're not eating enough to make up for your extra caloric need, because you're nursing, which requires calories, and you are exercising, which burns extra calories, then you can see that dip in supply. There's also a lot of conversations around not returning to super heavy weightlifting until you've stopped nursing, because of your hormones and how estrogen can be lower when you're breastfeeding, et cetera, and that was not substantiated as well in the systematic review that was published on the topic. So that is all good news.
Speaker 1:However, right and again, what we don't want to do is create barriers to exercise early for those that want to, and then we're also not going to ignore the very real, very massive life change that is having a new baby, whether it's your first child or your fifth. Right as soon as you're adding someone else into your world, there's increased care needs, there's sleep deprivation that depends on so many other factors, and one of the eight key point, the eighth key point is that these things matter. Right, like the postpartum period is an important transitional life event that presents unique barriers that might make getting to these guideline standards challenging. Right, we are going to acknowledge that. Yes, these are where the guidelines are, but it isn't always possible and it's not meant to shame or make new moms feel bad that they're not getting here. It's to remove the barriers to the people that can and to promote incremental changes in physical activity for those that can't make it to 120 minutes just yet. So robust social and emotional support from partners, family and society to help postpartum women and people overcome the challenges and barriers associated with this transition is essential to effectively move progress towards these recommendations. Lovely Bio-psychosocial lens, right, all of the other things, yes, body healing, but all of the ins and outs to our emotional and mental well-being includes those that are around us and the environment at which we are in that postpartum period, and I think that is so so, so, so, so beautiful to acknowledge.
Speaker 1:And the second, the ninth, one kind of, is the second recommendation along biopsychosocial factors, and it says it is essential to acknowledge that infant feeding and care significantly impacts daily life, including sleep. Thus, these recommendations may not always be achievable and at times, specific recommendations within this guideline will not align with current circumstances, right, there is so much that influences if a person can exercise or not, and this does not mean that we're going to make you feel bad. It means that we understand, and I love that the guideline says we understand, right, and that you know you're just doing the best you can Every day. You're just doing the best you can Every day. You're just doing the best you can. So, for postpartum women and people experiencing difficulties meeting these targets, even if small, doing any type of physical activity can improve maternal, physical and mental health, and any reductions in sedentary behavior may improve heart health. And so something is better than nothing, ideally, right. So we want to get to that guideline if we can, but something is better than nothing If your world is imploding around you, this is not something for you to feel guilty about. We have enough things as women in the pregnant postpartum period that make us feel bad, and so what this guideline does is it creates space, right. It creates space to allow individuals to explore movement, to delay movement if necessary, and to go at the pace that works for them, their body and that recovery within the sphere of their family, their support network, their environment, societal, cultural expectations, et cetera. Right, there's a lot of things that influence how a person engages with their life, and this guideline is very specific in trying to create space for those individuals.
Speaker 1:The final thing here and why I truly believe that I would be a postdoc for the rest of my life if I could to just be in this orbit even a little bit is that it is also acknowledged that even in 2025, we have so many gaps that we need to learn about Like gosh, I feel like every time Dr Margie Davenport and I meet so she's my postdoctoral supervisor. She's the first author on this guideline. I have this like section, so we meet and we take meeting notes. Every single time, her and I both end up on these tangents or I was on a course this week in teaching pelvic and the recommendations of things that people were saying that providers in their area were adhering to, the things that people were saying that providers in their area were adhering to it just always. I have a million research questions in my mind at all moments.
Speaker 1:It's just unreal how much we still have to learn, how much we need to do from a research perspective, and this is so exciting. This is the first guideline that we ever had, and not to mention just how comprehensive it is in general. It brings in other factors of a person's life, like sleep, right. There's going to be times where a nap is going to be more important than going out for that run and it creates this launching pad that we can leverage to still continue to do more work, and so I feel very fortunate to be in Dr Davenport's orbit, to be part of some of the Canadian research teams that are working on this, like Dr Michelle Mottola, dr Linda McLean, dr Jenna Schultz, dr Margie Davenport. There are so many researchers that are in Canada and not to mention internationally for sure Canada and not to mention internationally for sure. But as a Canadian, I'm just so proud to see that us in Canada are kind of leading the way with a lot of research, and then, you know, working with collaborators internationally is really exciting. So this is very cool.
Speaker 1:If you have any thoughts, questions about this, please let me know. Otherwise, we are just in this era of so many different papers and things coming out and I am just so excited to be able to share them all with you. I hope everybody has an incredible rest of the week. If you have any thoughts. Just let me know you should be able to grab that guideline. If you go to the British Journal of Sports Medicine under latest content, the full issue on postpartum return to movement is gonna be out like the published, like you can pick it up in paper form is gonna be out I think sometime in April. But all the content's there online now as a early release so you all can see it and I am just pumped. A great week everyone, and we'll see you.
